author image Justin Arocho, Ph.D.
author image Justin Arocho, Ph.D.
Dr. Arocho specializes in cognitive-behavioral therapy for anxiety disorders, OCD, depression, insomnia, and body-focused repetitive behaviors. He uses evidence-based treatments like ERP and CBT-I, and is fluent in Spanish. With a background in Psychology and Anthropology, he holds a Ph.D. in Clinical Psychology and has diverse experience across various mental health settings, including academia. Currently, he contributes as adjunct faculty at Rutgers University Behavioral Health Care, focusing on internship training and diversity issues.

Rumination is a common experience. If you have OCD, rumination can be a problem that makes your symptoms worse. Learn about this problem and what you can do about it.

Updated December 12, 2023

OCD and Mental Compulsions

Obsessive-compulsive disorder (OCD) is a distressing condition in which people experience obsessions or compulsions, and often both. Obsessions are unwanted, intrusive mental experiences (such as thoughts, images, or urges) that lead to anxiety and other painful emotions. Compulsions are behaviors that people use repeatedly to try to eliminate or lessen the anxiety and other painful emotions caused by obsessions. The “vicious cycle” of OCD is that compulsions can be effective in reducing anxiety – but only in the short term. Unfortunately, they feed the unhelpful cycle of OCD and actually make anxiety worse over time.

OCD can take many forms. When most people think about OCD, they think about the more observable types of obsessions and compulsions. A common example of this is someone with contamination obsessions, and compulsions like repeated handwashing. However, it’s important to note that mental compulsions are also common in OCD. They can come up in any subtype of OCD, or regardless of what topic or theme an obsession is focused on. Though mental compulsions aren’t visible to others, they play the same role as more overt compulsions and rituals.

Rumination is a Mental Compulsion

When it’s part of OCD, rumination plays the role of a mental compulsion. Rumination is a repetitive thought pattern in which you think about things over and over, in a continuous loop, as a way to analyze a particular thought. It tends to consume a lot of mental space and emotional energy, and feels draining to most people.

Rumination in OCD can be:

  • Repeatedly replaying or reviewing a past event in your mind in order to analyze it or accurately recall it
    • Visualizing the checkout experience from your trip to the grocery store to look for signs that you might have shoplifted
    • Recalling your conversation with a coworker to be sure you didn’t say anything inappropriate
  • Analyzing a question, philosophical, or existential topic in your mind in an attempt to find answers or understanding. This often lasts for a sustained period of time.
    • Thinking about if others perceive shapes and colors the same way you do to figure out if there’s something off about your experience
  • Repeating or rehearsing things that actively make you feel less anxious (this is a way of giving yourself reassurance)
    • Running through a list of facts about yourself in your mind that show you that you’re a good person who won’t harm others
    • Recounting the times your dating partner has treated you kindly to feel certain that your relationship is right
  • Keeping something in your mind on purpose to prevent a bad outcome from coming true, or controlling a scary risk
    • Continually playing a song with encouraging lyrics in your mind so nothing bad happens to your loved ones

Rumination isn’t unique to OCD – it can also be a part of other mental health concerns, such as depression or anxiety. For example, rumination in depression can lead someone to dwell and stew on disappointment or upsetting things from the past.

Rumination is a common mental compulsion in OCD because it feels like a way to resolve doubt. Discomfort with doubt or uncertainty is a core feature of OCD. Ruminating makes it feel possible to figure something out, to answer a question, verify the accuracy of a memory, arrive at a conclusion, or to otherwise eliminate doubt.

However, this is a trap! In OCD, rumination mimics problem-solving, but it’s actually quite different. When we’re problem solving, thinking something over actually does lead toward a helpful conclusion or solution. OCD rumination, however, tends to just keep looping or spiraling without end.

So, while rumination may not be observable by others, it functions similarly to all other compulsions in OCD, and tends to worsen anxiety and distress over time.

Treatment of Compulsive Rumination

Fortunately, OCD treatment works just as well regardless of whether or not you ruminate. Relief is possible! Cognitive-behavioral therapy (CBT) and, more specifically, exposure and response prevention (ERP) are the gold-standard psychological treatments for OCD, regardless of the specific themes that your obsessions center around or the compulsions that you engage in to try to control it. In a nutshell, ERP is learning how to ride out uncomfortable emotions (exposure to feared situations and the painful emotions themselves) while resisting the urge to do compulsions as a form of short-term relief (response prevention).

It’s not always easy to catch yourself ruminating, or to realize that it’s a mental compulsion you engage in. It can be so familiar to you that you don’t notice it at all, or perhaps not until you’ve already been sucked into it for a while. Working with an experienced ERP therapist can help you spot rumination and other mental compulsions and overcome OCD.

When dealing with OCD, it’s important to acknowledge that rumination is actually a behavior, even though it happens in your mind and may also be automatic or habitual. Simply having a thought is different from actively focusing on it, turning your attention toward it, or keeping your attention on it. These latter actions are what make rumination a behavior. When working with a ERP therapist, you and your therapist will discuss rumination as a behavior. Then you can make a plan to practice interrupting and resisting it, as you would for any other compulsion.

If you feel that rumination is a problem for you, please contact us for help.

author avatar
Justin Arocho, Ph.D. Assistant Director
Dr. Arocho specializes in cognitive-behavioral therapy for anxiety disorders, OCD, depression, insomnia, and body-focused repetitive behaviors. He uses evidence-based treatments like ERP and CBT-I, and is fluent in Spanish. With a background in Psychology and Anthropology, he holds a Ph.D. in Clinical Psychology and has diverse experience across various mental health settings, including academia. Currently, he contributes as adjunct faculty at Rutgers University Behavioral Health Care, focusing on internship training and diversity issues.

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